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PubMedDate not supplied

[Analgesic effect of imipramine in the treatment of ischium pain and circadian rhythm of cortisol release into the serum].

In the paper the results are presented of treatment of ischialgia with Imipramine, taking into account the circadian rhythm of cortisol release into the serum. The obtained results encourage to the use of tricyclic antidepressants in the treatment refractory cases of ischialgia. No significant differences were observed in the circadian rhythm of cortisol release into the serum before and after the treatment with Imipramine.

Adult↗
PubMed1998

[Fractures of the ischium after laminoarthrectomy. Retrospective study of a series of 31 patients].

PURPOSE OF THE STUDY: Pars interarticularis fracture is one possible source of pain after laminoarthrectomy. The purposes of this study were: to describe the pars defect, to determine its causes and to analyse its consequences on the functional final result. MATERIAL AND METHOD: 31 patients operated for disc herniation or degenerative lumbar stenosis were retrospectively studied. Clinical symptoms were evaluated before and 3 months after initial surgery, at the time of postlaminectomy radiological examination and at last follow-up according to Beaujon rating scale. Radiological evaluation included: description of the pars defect on plain radiographs and CT imaging, calculation of the amount of bone just above the inferior articular process that was resected, analysis of the postoperative stability of the spine both on static and dynamic radiographs. Any remaining disc herniation or stenosis were also noted. RESULTS: 39 pars interarticularis fractures were disclosed. These fractures were identified as a linear luency on plain radiographs or on reformed CT imaging view. Asymmetric widening of the facet joint space just below the pars defect was easier to observe and was present in 66 per cent of the cases on plain radiographs and in 79 per cent on CT imaging. After initial surgery 12 slipping appeared. In all of these cases pars fracture was bilateral at the same level or associated to a complete unilateral facetectomy at the same level. The amount of bone resected just above the inferior facet process was 66 per cent in average, range from 45 to 84 per cent. All the patients complained for low back pain and/or leg pain. In 62 per cent of cases symptoms occurred within one year after surgery, at an average onset of 7.6 months postlaminectomy. 27 patients were reported Revision surgery was in all cases a posterolateral fusion with or without instrumentation; new decompression was performed in 15 cases. At last follow-up, according to our classification, results were very good in 9 cases, good in 15 cases and fair in the remaining 3 cases. Improvement rate obtained after the initial surgery was 75 per cent in average, it was 59 per cent after revision surgery, difference was statistically significant. CONCLUSION: Pars interarticularis fractures may be a source of postlaminectomy pain. They appear to be caused primarily by an excessive resection (more than one half) of the bone immediately superior to the inferior articular process at the level of the laminectomy. These results suggest that caution in resection of this bone or additional posterolateral fusion in case of large resection of pars interarticularis, can avoid the problem. Asymmetric widening of the joint space just below the defect seems to be the key to this diagnosis in the postoperative lumbar laminectomy patient with persistent or recurrent pain.

Adult↗
PubMed1987

[Surgical treatment of decubitus ulcers in the area of the ischium, sacrum and trochanter major].

The operative management of pressure sores in the ischial, sacral and trochanteric region is based on the gluteus maximus muscle and its vascularization. Pressure sores in the sacral region were closed with eleven V-Y musculocutaneous flaps, for the ischial region with fifteen pendulum flaps, and for the trochanteric region with eight medial thigh flaps. In the four years follow-up of 24 patients three recurrences occurred and the post-operative morbidity was acceptable. The operative technique and the complications are further discussed.

Buttocks↗
PubMed1992

Acetabular micromotion as a measure of initial implant stability in primary hip arthroplasty. An in vitro comparison of different methods of initial acetabular component fixation.

Micromotion has been shown to affect bony ingrowth into cementless components. This study was designed both to quantitate initial micromotion at the prosthesis-periacetabular bony interface and to compare different methods of commonly employed acetabular component fixations, ie, a press-fit hemispherical titanium cup, a press-fit hemispherical titanium cup with one and two dome screws, a press-fit titanium hemispherical cup with three spikes, and a cemented chromium-cobalt cup. The press-fit component without screws demonstrated the greatest motion equaling 162 microns at the ilium, 97 microns at the publis, and 54 microns at the ischium. With one and two screws placed into the dome, the mean ileal displacement decreased by 28 microns (17%) and 36 microns (22%), respectively. Dome screw placement demonstrated a minimal effect at the pubis and ischium. Compared to the press-fit component without augmentation, the tri-spike motion was less at the pubis and ischium. The cemented prosthesis provided the least amount of motion in all three areas tested. This experiment demonstrates that the ilium provides the least amount of support to immediate acetabular fixation, while the pubis (anterior column) and ischium (posterior column) provide more stability. One dome screw does not affect the stability of a hemispherical prosthetic cup significantly. A two dome screw fixation provides an added method of support at the ilium, but fails to decrease motion at the pubis or ischium significantly. The tri-spike fixation does not restrict motion at the ilium to the extent as the dome screws, but its effect at the ischium and pubis is much more pronounced. The obvious difference between initial motion seen with cemented versus uncemented components may suggest that before surgery, patients may need a period of protected weight bearing until ingrowth has occurred.

Acetabulum↗
PubMedDate not supplied

Loss of bone mass after total hip replacement: preliminary data.

In a total of 37 females with cemented total hip replacement for monolateral coxarthrosis, of which 13 with prosthetic stem loosening, and 11 with monolateral coxarthrosis that is not prosthetized, bone mineral density (BMD) is determined by dual ray photonic absorbimetry selecting regions of interest (ROI) on the cortex of the femurs 4 cm under the lesser trochanter and on the ischium bilaterally. In females that are not prosthetized there are differences in bone mass between the two femurs and the ischium on both sides. In prosthetized patients BMD of the femur and of the ischium on the side operated on is significantly less than on the contralateral one (Student's "t" test: p < 0.001). In patients with stable prostheses, BMD of the femur operated on is greater than that in females with prosthetic stem loosening (Student's "t" test: p < 0.000). Based on a comparison between these two groups we did not observe any other significant differences in BMD among the ROI analyzed. BMD was correlated with the amount of time since surgery only in the ROIs in prosthetized femurs. The study confirms the significant bone resorption of the cortex in prosthetized femurs and documents analogously significant reduction in BMD in the ischium on the side operated on. Finally, it indicates that prosthetic stem loosening may be associated with loss of BMD in the femoral cortex which is significantly greater than that observed, during analogous periods of time in stable implants.

Aged↗
PubMed1992

Effects of sex steroids on the development of sexual dimorphism in mouse innominate bone.

The sexual dimorphism of the innominate bone was examined in 14 strains of mice. In female mice of all strains, the pubis was significantly longer and thinner than that in the strain-matched males. In 13 of 14 strains, the ischium in the male was longer and thicker than in the female. In the testicular-feminized male (Tfm) mouse, the ischium was longer and thinner than that in the wild-type male, resembling that of the wild-type female. The pubis of the Tfm mouse was longer than in the wild-type males. The pubis width in the Tfm mouse was between those of the wild-type male and female. Gonadectomy at ages of 5, 10, 20, 30, and 60 days in both sexes showed that the ischium develops as the female type when sex hormones are absent. In contrast, postnatal testicular androgen induces the male-type ischium. Gonadectomy at 60 days had a slight effect on the pubis, indicating that sexual dimorphism of the pubis was determined before 60 days of age. Estrogen receptors (ER) were immunohistochemically demonstrated in bone cells of 0- to 60-day-old mice. ER was found exclusively in the periosteum of the pubis at the day of birth; however, it appeared in bone cells of all parts of pelvis at 10-60 days. These results indicate that sexual dimorphism of the pubis is consistent for the 14 mouse strains examined, and that the shape of the pubis is determined by sex steroids before 60 days of age. Since ER exist in the bone cells, morphogenesis of the pelvis may be regulated by these sex steroids.

Animals↗
PubMed1993

Morphometric analysis of the pelvis in mice treated neonatally with tamoxifen.

The pelves of male and female C57BL/Tw mice given five daily injection of 100 micrograms tamoxifen, 50 micrograms dihydrotestosterone (DHT), or 2 micrograms diethylstilbestrol (DES) from the day of birth were examined morphometrically and histomorphometrically. Total areas of the pelvis, ilium, ischium, and pubis were significantly smaller in neonatally tamoxifen-treated mice than in the controls. There was no significant difference in length of the ischium between tamoxifen-treated and control mice of both sexes. However, lengths of ilium and pubis, and widths of ilium, pubis, and ischium in tamoxifen-treated male and female mice were significantly smaller than in the respective controls. In contrast, neonatal treatment with DHT or DES did not affect the shape of the pelvis of either sex. In the neonatally tamoxifen-treated females, the number of osteoblasts and osteoclasts per 200 microns trabecular surface length and per 10,000 microns2 subperiosteal area of pubic bone section was smaller than in the controls. Inhibition of ossification persisted in the junction of the pubis and ischium of pelves treated with tamoxifen in vitro. These results suggest that neonatally administered tamoxifen mainly retards the growth of the ilium and pubis in mice by changing the activities of osteoclasts and osteoblasts, and that tamoxifen acts directly on the neonatal mouse pubis to inhibit its ossification.

Animals↗
PubMed2002

Reproducibility of quantitative dynamic MRI of normal human tissues.

The aim of the study was to establish the normal range and to evaluate the reproducibility of dynamic contrast enhanced MRI (DCE-MRI) parameter estimates in normal human pelvic tissues. Nineteen patients with prostate cancer, undergoing androgen deprivation treatment, had paired DCE-MRI examinations of the pelvis using spoiled gradient-echo sequences. Quantitative enhancement parameters were calculated for each examination: transfer constant (K(trans)), leakage space (v(e)) and maximum contrast medium accumulation (MCMA) of pelvic muscles, bone marrow and fat. Descriptive and reproducibility statistics were calculated: within-patient standard deviation (wSD), repeatability and within-patient coefficient of variation (wCV). The femoral head and ischiorectal fat showed large numbers of non-enhancing pixels (81 and 88%, respectively). The ischial bone marrow had the highest values of kinetic parameter estimates (K(trans) 0.554 min(-1), v(e) 18.5% and MCMA 0.164 mmol/kg). Muscle parameters values were lower (K(trans) 0.126-0.137 min(-1), v(e) 10.6-11.5% and MCMA 0.077-0.086 mmol/kg). The mean difference between paired examinations was not significantly different from zero for any parameter. v(e) and MCMA had the lowest wCV (between 19 and 29%). For individuals, a log(10) K(trans) change of approximately 0.90 in muscles and 0.52 in the ischium would be statistically significant. The corresponding absolute changes for v(e) are 6.7% in muscle and 13.6% in the ischium. For a group of 19 patients, small changes are statistically significant (muscle log(10) K(trans) 0.208 and v(e) 1.5% and ischium log(10) K(trans) 0.123 and v(e) 3.1%). Fat and the femoral head are unreliable tissues from which to obtain kinetic parameter estimates due to poor enhancement. v(e) and MCMA have smaller coefficient of variation than K(trans) in muscles and ischium. Reproducibility studies of normal and pathological tissues should be incorporated into clinical research protocols that measure treatment effects by DCE-MRI techniques.

Adipose Tissue↗
PubMed2007

The proximal origin of the hamstrings and surrounding anatomy encountered during repair. A cadaveric study.

BACKGROUND: Avulsion of the proximal origin of the hamstrings has become a more frequently recognized athletic injury. Most orthopaedic surgeons rarely operate in this anatomic area. The purpose of the present study was to define the anatomy of the proximal origin of the hamstrings and its relationship to neurovascular and muscular structures encountered during a repair of a complete avulsion. METHODS: Fourteen fresh-frozen hip-to-foot human cadaveric specimens were dissected in the prone position. The proximal origin of the hamstrings and its relationship to the surrounding neurologic and muscular structures were documented and measured with use of digital calipers. RESULTS: Six of the fourteen specimens were from female donors. The average age of the donors at the time of death was 68 +/- 13 years. The average height of the donors was 66 +/- 3.5 in (167 +/- 8.9 cm), and the average weight was 142 +/- 39 lb (64 +/- 17.7 kg). The semitendinosus and biceps femoris have a common tendinous site of origin on the ischium. A number of measurements were obtained. The musculotendinous junctions of the semitendinosus and biceps femoris separated at an average of 9.9 +/- 1.5 cm from the most proximal origin site on the ischium. The average distance from the proximal border of the semitendinosus/biceps femoris origin to the inferior border of the gluteus maximus was 6.3 +/- 1.3 cm. At the lateral border of the ischium, the average distance from the inferior gluteal nerve and artery to the inferior border of the gluteus maximus was 5.0 +/- 0.8 cm. The sciatic nerve was an average of 1.2 +/- 0.2 cm from the most lateral aspect of the ischial tuberosity. The site of origin of the semitendinosus/biceps femoris was oval, with average measurements of 2.7 +/- 0.5 cm from proximal to distal and of 1.8 +/- 0.2 cm from medial to lateral. The site of origin of the semimembranosus was crescent-shaped, with average measurements of 3.1 +/- 0.3 cm from proximal to distal and of 1.1 +/- 0.5 cm from medial to lateral. CONCLUSIONS: The semitendinosus and biceps femoris have a common tendon of origin on the ischium, and the semimembranosus originates just laterally. The proximal origin of the hamstrings has intimate relationships with the inferior gluteal nerve and artery and the sciatic nerve, which may be at risk during surgical dissection and retraction.

Aged↗
PubMed2005

False positive 18F-FDG PET in an ischial chondroblastoma; an analysis of glucose transporter 1 and hexokinase II expression.

We report a rare case of chondroblastoma arising from the ischium which showed an increased (18)F-FDG uptake. Chondroblastoma is an uncommon lesion and usually involves the epiphysis of long bones. However, in this case, the tumor appeared as a well-defined osteolytic lesion in the ischium on radiographs. MR imaging demonstrated two components in the tumor: a solid one and a multilobular cystic component. (18)F-FDG PET imaging revealed an increased uptake in the ischium. The (18)F-FDG uptake resembled the results observed in malignant bone tumors. A histological diagnosis of chondroblastoma was obtained from tissue of an open biopsy. An immunohistochemical analysis demonstrated weak expression of both Glut-1 and HK-II. These findings suggest that Glut-1 and HK-II expression are not strongly related to FDG uptake in chondroblastoma.

Adult↗
PubMed2005

[Minimally-invasive regional treatment of a symptomatic ischial metastasis using radiofrequency ablation and osteoplasty].

HISTORY AND ADMISSION FINDINGS: A 46-year-old woman presented with worsening, morphine-resistant pain during the previous 8 weeks in the right ischium which rendered her immobile. The patient refused further surgery, radiotherapy or chemotherapy, as she had been treated for ovarian cancer and recurring rectal carcinoma with peritoneal carcinomatosis for the last three years almost without interruption and experienced several complications. The pelvic region had radiotherapy up to 70,4 Gy. INVESTIGATION: Scintigraphy of the bone showed enhancement in the right ischium. Conventional radiography demonstrated an irregular lesion with destruction of the corticalis 3 x 4 cm in size. Computed tomography revealed numerous microfractures and pseudo-arthritic changes. Needle biopsy confirmed a bone metastasis from the rectal carcinoma. Examination of radiation fields showed a high risk for radiation damage using conventional fractionation. TREATMENT AND COURSE: After achieving an interdisciplinary consensus the metastatic lesion of the patient under analgesia and sedation was thermo-ablated by using radiofrequency percutaneously under ct-control and filled with bone cement. 8 days later the patient was released from hospital pain-free and mobile. Her Karnofsky index rose from 30 % to 90 %. Morphine could be reduced to zero. No complications occurred. 9 month later, though newly appearing lung metastasis, the lesion of the ischium was still asymptomatic and stable and conventional radiography did not indicate local tumor progress or dislocated bone cement. The patient now agreed to further chemotherapy. CONCLUSION: Palliative minimally invasive radiofrequency ablation with concurrent osteoplasty can be effective in individual cases giving a better quality of life and mobility. Benefits and risks should be carefully evaluated in studies examining quality of life, especially in patients without the options of surgical and radiotherapy.

Biopsy, Needle↗
PubMed1988

Avulsion of the hamstring muscles from the ischial tuberosity. A report of two cases.

In two rare cases with avulsion of the hamstring muscles from the ischial tuberosity without fracture of the ischium, the clinical features were: (1) sudden onset of pain in the buttock; (2) difficulty on standing after trauma; (3) a palpable defect and tenderness on the area distal from the ischial tuberosity; and (4) weakness of flexion of the knee with a loss of normal outline of the hamstring muscles on the dorsal aspect of the knee. There was no roentgenologic evidence of fracture of the ischium. Surgical repair with reattachment of avulsed muscles to the ischium and proximal tendinous sheaths of the muscles restored function or corrected deformity.

Adolescent↗